go back

Nursing Facility Evaluation for Acute Change in Condition

South Carolina rates for HCPCS G9685

Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. This service is for a demonstration project

Rates data updated July 2026.

How much does Nursing Facility Evaluation for Acute Change in Condition cost?

$158

Typical physician fee. In South Carolina, July 2026.

Insurers have agreed to pay about $158 for this service. Most negotiated rates run $158 to $191.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $158 · 10th to 90th $158 to $245Professionalmedian $158 · 10th to 90th $158 to $191
$200$500facility $158professional $158

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$234.42
Typical High
$234.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Medcost
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$186.21
Typical High
$512.86
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$229.09
Typical High
$295.12

Where South Carolina sits

The same service costs 3.5 times more in Alaska than in Indiana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Carolina· 42nd of 51

$158

AK $468IN $135

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.